Acute Lung Injury and Acute Respiratory Distress Syndrome

The acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and Petty. Since its original description there has been significant progress with regard to etiology, epidemiology, pathophysiology, pathogenesis, and treatment. Substantial progress has been made by both clinical and basic scientists with regard to understanding the molecular, cellular, and physiological mechanisms required for the development and resolution of clinically relevant acute lung injury (ALI) and ARDS. Importantly, based on the understanding of the pathogenesis of this lung disease, significant clinical progress has evolved in the treatment of ALI/ARDS. Although survival has improved, there is still a significant attributable morbidity and mortality secondary to ALI/ARDS. Thus there is a need to extend our current understanding of how ALI/ARDS develops and resolves and to develop novel approaches to prevent and treat the continuum of ALI to ARDS. This issue of Seminars in Respiratory and Critical Care Medicine is dedicated to ALI/ARDS and integrates both basic and clinical science, providing a comprehensive perspective on epidemiology, genomics, diagnosis, pathogenesis, and treatment of this disease.

Dr. Frutos-Vivar and colleagues provide an overview on how the definition of ALI/ARDS has evolved and the latest epidemiology data. A comprehensive summary of the pathogenesis (i.e., from inflammation and endothelial/epithelial damage to fibroproliferative/fibrosis of ALI/ARDS) is given by Dr. Ware. Dr. Belperio and colleagues review the role of cytokines during the pathogenesis of ventilator-associated and ventilator-induced lung injury, both disease entities caused by mechanical ventilation that can perpetuate ALI/ARDS as well as propagate multiorgan dysfunction syndrome. Dr. Bastarache and colleagues then discuss the role of the coagulation cascade in the continuum of sepsis and ALI/ARDS.

Drs. Lewis and Veldhuizen provide an update on clinical trials of surfactant replacement in patients with lung injury and the potential future of surfactant therapy during ALI/ARDS. Important advances in understanding the genomics of ALI/ARDS are given by Dr. Flores and colleagues, giving light to the possibility of personalized medicine in the intensive critical care unit. Dr. MacIntyre provides the latest insight on different strategies of mechanical ventilator management during ALI/ARDS, and Dr. Caironi and colleagues give an overview of radiographic characteristics, including findings from computerized axial tomography of ALI/ARDS. Dr. Brown and colleagues explain the role of extracorporeal life support and liquid ventilation for ALI/ARDS in adults. Lastly, Drs. Levitt and Matthay provide a historical perspective and potential future directions for therapies with regard to the treatment of ALI/ARDS.

Since its original description in 1967, significant progress has been made in understanding, preventing, and treating ALI/ARDS. However, novel clinical and basic science studies will be required to further reduce the incidence and mortality associated with ALI/ARDS. We would like to thank all the contributors for their hard work in preparing this issue of Seminars in Respiratory and Critical Care Medicine dedicated to ALI/ARDS.